A rare cause of intestinal obstruction: right paraduodenal hernia.

Internal herniation is an extremely rare cause of intestinal obstruction. Paraduodenal hernias result from abnormal rotation of the bowel. Symptoms that may range from recurrent abdominal pain to acute obstruction may occur. If it is not diagnosed and treated in time, the disease may result in intestinal ischemia. This article aimed to present the diagnosis and treatment process of a 47-year-old male presenting with acute abdomen symptoms by evaluating retrospectively with the accompaniment of literature. During the abdominal exploration of the patient, nearly all of the intestines were observed to be herniated from the right paraduodenal region to the posterior area. The opening of the hernial sac was repaired primarily by reducing the intestinal bowel loops into the intraperitoneal region. The patient undergoing anastomosis by performing resection of the ischemic part after reduction of herniated bowel loops was discharged uneventfully on the post-operative 10th day. Paraduodenal hernia is a condition that should be considered in patients with abdominal pain and intestinal obstruction symptoms. Early diagnosis is of vital importance to prevent the complications which can develop.

[Intestinal malrotation accompanied by a right paraduodenal hernia in an adult: a case report].

A 72-year-old woman was admitted to our department in March 2020 for an evaluation of nausea, vomiting, diarrhea, liver dysfunction, and hypokalemia, which had persisted intermittently since 2013. Thickening of the descending duodenal wall and a sac-like appearance the intestinal tract in the vicinity of the duodenal papilla were observed in abdominal computed tomography. No duodenojejunal curvature, with two intestinal loops identified in the descending region, was detected in contrast-enhanced upper gastrointestinal imaging. Based on these imaging findings, the patient was diagnosed with intestinal malrotation (incomplete rotation and fixation) accompanied by a right paraduodenal hernia based on the Nishijima classification. Thus, surgery was performed at our hospital. Gastrointestinal symptoms did not recur, and liver dysfunction and hypokalemia improved postoperatively.

Multi-slice spiral computed tomography diagnosis of juxta-papillary duodenal diverticulum and its relationship with biliopancreatic diseases.

BACKGROUND: Juxta-papillary duodenal diverticula (JPDD) are common but are usually asymptomatic, and they are often diagnosed by coincidence. OBJECTIVE: To analyse the anatomy and classification of JPDD and its relationship with biliary and pancreatic disorders, and to explore the diagnostic value of multi-slice spiral computed tomography (MSCT) in patients with JPDD. METHODS: The imaging data of patients with JPDD, which was obtained via abdominal computed tomography examination and confirmed via gastroscopy and/or upper gastrointestinal barium enema, in our hospital from 1 January 2019 to 31 December 2020 were retrospectively analysed. All patients were scanned using MSCT, and the imaging findings, classification and grading were analysed. RESULTS: A total of 119 duodenal diverticula were detected in 96 patients, including 73 single diverticula and 23 multiple diverticula. The imaging findings were mainly cystic lesions of the inner wall of the duodenum protruding to the outside of the cavity. The thin layer showed a narrow neck connected with the duodenal cavity, and the shape and size of the diverticula were different: 67 central-type cases and 29 peripheral-type cases. There were 50 cases of type I, 33 cases of type II, 19 cases of type III and six cases of type IV. Furthermore, there were seven small, 87 medium and 14 large diverticula. The differences in the location and size of the JPDD in MSCT grading were statistically significant (P< 0.05). CONCLUSION: The MSCT method has an important diagnostic value for the classification of JPDD, and MSCT images are helpful in the clinical evaluation of patients with JPDD and the selection of treatment options.

Lessons learnt in the management of paraduodenal hernias: a case series.

INTRODUCTION: Paraduodenal hernias (PDH) are rare congenital internal hernias with non- specific symptoms. Left-sided paraduodenal hernia is three times more common than right-sided paraduodenal hernia with similar clinical presentation but different embryological origins. MATERIALS AND METHODS: We report a series of eight cases of paraduodenal hernia who presented with varied clinical presentation ranging from vague abdominal pain to complete intestinal obstruction. Six cases had left-sided paraduodenal hernia, while two cases had right-sided paraduodenal hernia. RESULTS: Seven cases based on their presentation underwent surgery either electively or on emergent basis. Three cases underwent laparoscopic repair. One case had a recurrence and was re-operated four months later. There was no mortality among any of the cases. CONCLUSION: A pre-operative diagnosis of paraduodenal hernia is essential. Laparoscopic surgery is safe in select cases and is found to be beneficial.

Right paraduodenal hernia, classification, and selection of surgical methods: a case report and review of the literature.

BACKGROUND: Considering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features. CASE PRESENTATION: The case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years. CONCLUSION: Although right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy.

Case of split notochord syndrome: a neonate with thoracic neuroenteric cyst, abdominal duodenal duplication cyst, malrotation and vertebral anomalies.

The authors describe a case of a male neonate with split notochord syndrome presenting with cervico-thoracic deformity, thoracic neuroenteric cyst, separate abdominal duodenal duplication cyst and concurrent intestinal malrotation. This combination of abnormalities is very rare. When these lesions are suspected, patients must be investigated carefully.This case is presented not only to recount an infrequent combination of structural abnormalities but also to raise awareness of the signs that should point to clinical suspicion and prompt diagnosis.Following surgical excision of the thoracic neuroenteric cyst, the patient has made a good recovery.

Endoscopic treatment of periampullary duodenal duplication cyts in an 18-month-old girl.

BACKGROUND: Duodenal duplication cysts (DDC) are rare congenital anomalies of the gastrointestinal tract and periampullary localization with anatomical variants including biliary and pancreatic duct anomalies remains a surgical challenge. Endoscopic treatment of the periampullary DDC (PDDC) communicating with the pancreaticobiliary duct in an 18-month-old girl is presented to discuss the endoscopic treatment options in children. CASE: An 18-month-old girl with a normal prenatal ultrasound (US) was asymptomatic until complaining of abdominal pain and vomiting at 10-months of age. Abdominal US revealed a 1.8 × 2 cm cystic mass adjacent to the second part of the duodenum. The amylase and lipase levels were slightly increased while she was symptomatic. Magnetic resonance cholangiopancreaticography (MRCP) showed a thick cyst wall measuring 1.5 × 2 cm at the second part of the duodenum, consistent with DDC that was suspected to be communicating with the common bile duct. Upper gastrointestinal endoscopy confirmed a bulging cyst in the duodenum lumen. The puncture and injection of the cyst with contrast material confirmed the communication of the duplication cyst with the common bile duct. The unroofing of the cyst was performed with endoscopic cautery. The biopsy obtained from the cystic mucosa revealed normal intestinal histology. Oral feeding was initiated six hours after the endoscopy. The patient has been followed for the last 8 months uneventfully. CONCLUSIONS: Endoscopic treatment of PDDC with various anatomical variants can be considered an alternative to surgical excision in children.

Large left paraduodenal hernia identified and repaired by laparoscopy: A case report.

Paraduodenal hernias (PDHs) are rare types of internal hernias that pose a significant diagnostic and therapeutic challenge because they can present with non-specific symptoms ranging from digestive disorders and chronic abdominal pain to symptoms of intestinal obstruction which may be life-threatening. We describe here a woman in her early 30's who presented to the emergency department with a three-hour history of generalized intermittent crampy abdominal pain. She had experienced multiple similar episodes of this pain over the past 20 years. Totally laparoscopic technique was used to complete the diagnosis and treatment of a large left PHD with accompanying acute intestinal obstruction. The operation was successful and the patient was discharged from hospital 10 days later. PDH should be considered if a patient complains of recurrent abdominal pain without any other obvious explanation; a laparoscopic approach can be used to identify and repair the hernia.

Intestinal obstruction secondary to Brunner's glands hyperplasia.

Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or imaging tests as they are small and asymptomatic. In the case of symptomatic tumors, resection of the lesion is indicated. In lesions ≤2 cm, endoscopic resection can be chosen, reserving surgery for larger lesions or endoscopically inaccessible ones. We present the case of a patient with a history of vomiting and hyporexia of months of evolution who presented peptic ulcer perforation and underwent surgery. During follow-up, she presented intestinal obstruction due to pyloric stenosis. Given the impossibility of ruling out a neoplastic process with certainty in diagnostic tests, surgical resection (antrectomy) was decided with an anatomopathological finding of Brunner's gland hyperplasia.

Une Liaison Dangereuse: Spontaneous Pyeloduodenal Fistula.

We describe the case of a 76-year-old woman with a spontaneous nephroduodenal fistula. The patient was initially evaluated for gastrointestinal and urinary symptoms associated with fever and anemia, after which she was admitted with the diagnosis of right chronic pyelonephritis, hydronephrosis, and renal lithiasis. The fistula was diagnosed incidentally by percutaneous pyelography during a right nephrostomy and was later confirmed with an abdominal CT scan. A multidisciplinary decision was made to surgically treat the fistula (right nephrectomy plus duodenal repair); the surgery had a short-term positive outcome. We report a systematic review of the literature related to spontaneous pyeloduodenal fistulæ and their treatments.

Duodenal Web in an Elderly Patient with Abdominal Discomfort and Vomiting: A Rare Case.

Duodenal web is complete or incomplete obstruction of the duodenum due to a membranous web or intraluminal diverticulum. This abnormality is one of the main causes of intestinal obstruction in children. The symptoms of this disease may rarely appear in older age and cause gastric outlet obstruction in adults. In the present paper, we report a 69-year-old male patient with heartburn, abdominal discomfort, frequent non-bilious, non-bloody vomiting for the past 6 months. Furthermore, the patient had experienced a weight loss of 12 kg during this period. He had been taking aspirin daily for years due to his ischemic heart disease. After performing contrast-enhanced CT imaging, esophagogastroduodenoscopy and barium meal examination, the patient was diagnosed to suffer from duodenal web. Since surgery is currently the mainstay of treatment in the management of this disease, the patient finally underwent a gastrojejunostomy.